HomeMy WebLinkAboutCHANGE OF CONTRACTOR - SUB CONTRACTOR - CANCEL PERMITSCANNED
By
PLANNING & DEVELOPMENT SERVICES
BUILDING & ZONING,DIVISION —
k 2300 VIRGINIA AVE RECEIVED
• A
FORT PIERCE, FL 34982
(772) 462-1553 FAX 462-1578 N 0 V 0 6 2 018
ST. Lucie County, Permitting
CHANGE OF CONTRACTOR- SUBCONTRACTOR OR CANCELLATION OF PiERIVfr
LEASE SELECT ONE OF THE FOLLOWING:
CHANGE OF CONTRACTOR— Change of Contractor is to be signed and notarized by the property owner, '
id the new contractor of record for the current permit. A new permit application must also be.completed with new
infractor information and signature. A new Notice of Commencement must be filed in the new contractor's name
�r job values greater than $2,500 ($7,500 if A/C Change -out). A recorded copy must be - submitted prior to
mmencmg any work. There is a $50.00 fee for the Change of Contractor.
CHANGE OF SUBCONTRACTOR — Subcontractor changes are to be completed by the general contractor. d
� e new subcontractor must fill out a Subcontractor Agreement Form. There is a $50.00 fee for the Change of Sub-
ontractor.
CANCELLATION OF PERMIT — The cancellation of a permit is acceptable only if no work has been done.
incellation of permit is to be signed and notarized by both the owner and qualifier of record. There is no fee for
ncellation of the permit.
ate: (n Permit Number:: / goo —�o 7 S®
I
Si�e Address: 27 /-S— S Iid,%I
Y Q P Le s eJti
O iginal GC, subcontractor or owneribuilder
a . t) A,efZ
Ne,'w GC, subcontractor
R on for Cancellation.
2c vest._ 0(& lj /27" 1J , � ? V96D Z
State License SLC License a 9 74 K
State License_ SLC License
T
6 undersigned does hereby agree to indemnify and hold harmless St Lucie County, its officers, agents, and employees from all
co
its, fees or damages arising fro any and all claims of action for any reason, which may arise as a result of this change of
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for/subcon actor or cane ation f permit. A permit cannot be cancelled if work has been performer#.
SI
RE OF OWNER o owner/builder)
SIGNATURE GENERAL CONTRACTOR (or new GC, es applicable)
�! 7
NAME 'S %I t-11
MINT
i
. C�
PRINT NAME
St
ilI e of Florida, County of St. Lucie County
State of Florida, County of St. Lucie County
q
e following instrument was ackn wledged before me this
The following instrument was acknowledged before me this
day of 20 by
of 20_, by '
r�hobasproducgd^
who is personally known to me
V6i-16L as ID.
who is personally known to
me or who has produced as ID.
Si
ature of Notary Date
Signature of Notary Date
Re•sed
04/15/16